Revisiting Early Uses of Diphtheria Anti-Toxin in the United States
I’ve previously written about an early use of diphtheria anti-toxin in the United States, on October 16, 1894. A pair of young Cincinnati physicians managed to find some anti-toxin in the possession of a local doctor who had brought it back from Europe. They treated a young girl who survived, and a Cincinnati newspaper trumpeted on October 20 that the doctors had used the new serum. The typescript memoir of this incident says that this was the first use of anti-toxin in the country, but I knew that there were probably other uses around this time. A recent note from an NIH researcher prompted me to look at the timing once again to try to establish, if not the definitive first use of anti-toxin in the states, then at least an earlier use than the one in Ohio.
Emile Roux of the Pasteur Institute had been systematically investigating the use of anti-toxin in sick children at the Hôpital des Enfants Malades in Paris since February 1894. In Berlin at the Institute for Infectious Diseases (the Koch Institute), similar studies were being done. At the International Congress of Hygiene and Demography in Budapest in early September 1894, Roux reported a convincing reduction in case fatality with use of the serum. Many U.S. physicians, making their annual European summer visits in 1894, would have heard about the use of the anti-toxin in Berlin and Paris, and many brought back small quantities of the serum.
I had thought it was quite likely that anti-toxin was used in New York before the Cleveland use on October 16, 1894, especially because of the expertise of William Hallock Park, bacteriologist and physician with the New York City Health Department, in diphtheria control. Indeed, Park’s superior at the Health Department, Hermann M. Biggs, MD, went to Europe in June and returned in late September with a small amount of anti-toxin. (See below for Biggs’s role in initiating production of anti-toxin in New York.)
The earliest mention of the use of diphtheria anti-toxin I came across, however, had nothing to do with Biggs’s trip and small supply. Campbell White, MD, practicing at Willard Parker Hospital (a public hospital for communicable diseases on East 16th Street in New York City) described using anti-toxin as early as July 1894. In the November 17, 1894, issue of the weekly New York journal the Medical Record, he wrote, “The treatment with the antitoxin was begun in the latter part of July, having previously used the weaker solution on several cases [to attempt to immunize], and extended through the following two months” (White, Medical Record). In another paper published around the same time, he wrote, “[Cases of laryngeal and naso-pharyngeal diphtheria] are always dangerous at any season of the year and in any epidemic. It was from this class of cases that patients were selected at the hospital for anti-toxine treatment. The serum used was that made by Aronson [in Berlin], and was furnished by Schering and Glatz, the agents in this country. In no case were the injections followed by signs of local inflammation. Twenty cases were treated during August and September. They were all serious cases with an unfavorable prognosis….Five of these patients (25 per cent.) died” (White, The Society Proceedings of the Meeting of New York Academy of Medicine).
Campbell’s first-hand contemporary account contradicts what Evelynn Hammonds wrote in Childhood’s Deadly Scourge (Johns Hopkins University Press, 1999): “Toward the end of November, Dr. A. Campbell White purportedly used anti-toxin for the first time in New York City on twenty cases at the Willard Parker Hospital. Antitoxin was the only treatment given to the children with severe cases of diphtheria. Only five of the children died, whereas typically less than half would have been expected to survive. Campbell commented that he believed that antitoxin, given early in the disease and in sufficient quantity, prevented death by ‘the absorption of the toxine of diphtheria.’ The Times lauded Campbell’s results, calling them the ‘first important and conclusive contribution from America….We are glad it has been furnished by New York.” But the source she used to back up her November 1894 claim was a New York Times article that, though published in November 1894, didn’t actually mention when White used the remedy.
I found a few other early reports of anti-toxin use from doctors in isolated cases.
- Louis Fischer, MD, a physician with appointments at the Messiah Home for Children in the Bronx and a hospital in Berlin, reported in the Medical Record of October 6, 1894, that he had used diphtheria anti-toxin to treat a girl who had early signs of diphtheria after exposure to a sick boy in her tenement. I presume this occurred in New York and would have had to happen several days if not weeks before the publication date. Fischer noted that he had used Dr. Hans Aronson’s “Heilserum,” which he had obtained on a recent trip to Berlin. Fischer also described this event to a reporter for the New York Times (Only One Case Fatal – Dr. Louis Fischer’s Great Success with Anti-Toxine, December 2, 1894).
- WS Gleason, MD, wrote a case report in the November 10, 1894, issue of the Medical Record. He describes using Aronson’s antitoxin to successfully treat a Newburgh, NY, boy with diphtheria and scarlet fever on October 12, 1894. (Note that this report appeared in print before White’s more comprehensive description of the July/August use of anti-toxin at Willard Parker Hospital.)
- According to Wade W. Oliver’s The Man Who Lived for Tomorrow (1941), Biggs gave some of the serum he’d brought from Europe to the New York Children’s Asylum in Mt. Vernon, Westchester County, NY, to immunize the home’s population after diphtheria had emerged in late September 1894. Oliver cites as his source for this date Park’s 1929 Who’s Who Among the Microbes. Park’s book, however, doesn’t give a precise date for the incident. Another accounting of this incident, written in 1897, states that the anti-toxin provided by Biggs to the Westchester home was first used on December 12, 1894, on 21 children at the asylum who were not ill with diphtheria but whose throat cultures showed evidence of the bacteria (another 21 children were in a control group) (Peck, 1897). Another article in the Medical Record also uses the December 12 date for this incident, so I think Oliver confused the timing of Biggs’s return from Europe with the use of the anti-toxin.
At the same time as these early uses of diphtheria anti-toxin, we know that Park, Biggs’s colleague at the Health Department and pioneer in the control of diphtheria, was beginning to immunize animals at a stable at the New York College of Veterinary Surgeons on East 57th Street. While abroad, Biggs had cabled Park to begin producing toxin in anticipation of making anti-toxin, and he also cabled the Commissioner of Health to notify him that he wanted to produce City-funded anti-toxin for the poor. The Health Commissioner gave Biggs’s proposal to the Board of Health and the Board of Estimates, requesting about $30,000 in funding. The Board of Estimates declined to fund the project, but indicated a willingness to reconsider the proposal at its meeting on December 20, 1894. At this point, funding for Park’s efforts was probably supplied by private donors so that he could begin work (Hammonds, 1999). The funding would come through in December, along with a donation from a fundraising effort by the New York Herald (Anti-Toxine for the Poor, December 10, 1894).
After some difficulties producing toxin in the lab, Park began using it to immunize goats, sheep, dogs, and a cow in early October 1894. He soon switched to horses, an animal that would produce larger amounts of anti-toxin and that Roux had recommended be used. But sufficient quantities of antitoxin for dispensation would not be available until after January 1 (Biggs, 1895).
So in fall 1894 the Board of Health wasn’t yet producing anti-toxin in meaningful quantities and supplies from Europe were limited. Francophile physicians in New Orleans, however, had been reading about the serum in the Parisian daily Le Figaro and were anxious to get their hands on some of it. Around November 9, after a meeting, they sent cables to Europe to try to secure a supply of the anti-toxin, but found it too difficult to locate and ship. They next inquired with Paul Gibier, MD, head of the New York Biological and Vaccinal Institute (the Pasteur Institute in Manhattan). He sent them a shipment of 15 bottles of diphtheria anti-toxin, valuing $41. (In one account in the New York Herald, Gibier said that he had learned of anti-toxin from the New Orleans group and had begun to prepare it after their inquiry. If this is true, they must have contacted Gibier several months prior to November, as he it took him about two months to prepare the horses to produce the anti-toxin). The Diphtheria Anti-Toxine Commission of New Orleans reported that the first use of diphtheria anti-toxin in that city was November 18, 1894, described in a report dated 12/23/1894.
In the midst of excitement in Europe over the promising treatment, and plenty of trans-Atlantic traffic in private and commercial shipping of anti-toxin, July or August 1894 is the earliest date I’ve been able to find for its use in the United States. If any reader knows of an earlier date, please share the source with us here in the comments section.
Anti-Toxine for the Poor. New York Herald. December 10, 1894. Page 3.
Biggs HM. Some experiences in the production and use of diphtheria antitoxin. Medical Record, April 20, 1895, 481-84.
The Blood-Serum Remedy for Diphtheria. New York Times, 12/3/94.
Hammonds EM. Childhood’s deadly scourge: the campaign to control diphtheria in New York City, 1880-1930. Baltimore: Johns Hopkins University Press, 1999.
History, proceedings, and repots of the Diphtheria Antitoxine Commission of New Orleans. November 7, 1894 to March 7, 1895.
Markel, HM. Long Ago Against Diphtheria, the Heroes Were Horses. New York Times. July 10, 2007. http://www.nytimes.com/2007/07/10/health/10hors.html
The New Remedy for Diphtheria. New York Times, October 28, 1894.
Oliver WW. The man who lived for tomorrow. New York: E.P. Dutton, 1941.
Park WH, Williams AW. Who's who among the microbes. New York: Century, 1929.
Peck GA. Immunization against diphtheria with antitoxin. Transactions of the New York Academy of Medicine, volume 12, April 29, 1895.
Peck GA. Immunization against diphtheria with antitoxin. Medical Record, vol. 87, no. April 20, 1895, 486-87.
White AC. The anti-toxine treatment of diphtheria based upon a series of cases treated at Willard Parker Hospital. Annals of Medical Practice, vol. 8. November 8, 1894.
White AC. The treatment of diphtheria with anti-toxin. Based upon a series of cases treated at Willard Parker Hospital with “Antitoxin Schering.” Medical Record, vol. 46, no. 20. November 17, 1894.
White AC. The anti-toxine treatment of diphtheria based upon a series of patients treated at Willard Parker Hospital. A paper presented November 8, 1894, at the New York Academy of Medicine, Section of Paediatrics meeting. Reprinted several places, including The Society Proceedings of the Meeting of New York Academy of Medicine.